An Exceptional Case of Garcin Syndrome Mimicking Bell's Palsy in Advanced Non-Small Cell Lung Carcinoma

Garcin syndrome is an exceptional clinical condition characterized by progressive multiple ipsilateral cranial nerve involvement which is caused by malignant osteoclastic lesion at skull base. We report a rare case of Garcin syndrome which was misdiagnosed as Bell's palsy. A 69-year-old lady, presented with generalized headache and right facial nerve palsy in which progressively worsened even after treatment with corticosteroid. Computed tomography (CT) brain showed skull base erosion suggesting tuberculosis or metastatic lesion. Mass at the left hilar region was seen from her chest x-ray which raise suspicion of lung malignancy after tuberculosis has been ruled out. A month later, she developed worsening right facial nerve palsy followed by multiple cranial nerve involvement on the ipsilateral side. CT staging revealed features of lung malignancy with loco-regional and distant metastases to liver and spine. Histopathological diagnosis of non-small cell lung carcinoma was established after biopsy during bronchoscopy.